心肌型脂肪酸结合蛋白联合血浆D-二聚体对肺栓塞预后评估的临床意义

Prognostic values of heart-type fatty acid-binding protein and D-dimer level in plasma in acute pulmonary embolism patients

目的：探讨心肌型脂肪酸结合蛋白（H-FABP ）联合血浆 D-二聚体在评价急性肺栓塞（APE）患者预后中的临床价值。方法选取本院2011年1月至2014年12月确诊的APE患者120例为研究对象，采用酶联免疫吸附法分别测定外周血H-FABP及D-二聚体浓度。根据病情严重程度将APE患者分为低危组、中危组及高危组；根据临床转归，分为存活组和死亡组，比较不同组间H-FABP和D-二聚体差异，评价H-FABP和D-二聚体对评估APE患者预后的临床价值。结果随着APE患者病情严重程度的增加，H-FABP和D-二聚体指标水平显著升高（P＜0.05）；死亡组H-FABP和D-二聚体水平显著高于存活组（P＜0.05）。相关性分析显示，血浆H-FABP与D-二聚体水平呈正相关（r=0.693，P=0.000）。ROC曲线分析显示，H-FABP曲线下面积为0.845（95%CI：0.752～0.918），其最佳工作点为8.65μg/L，此时诊断APE的敏感性为81.24%，特异性为84.14%；D-二聚体曲线下面积为0.832（95%CI：0.728～0.899），其最佳工作点为1.25 mg/L，此时诊断APE的敏感性为83.72%，特异性为82.65%。结论 H-FABP联合D-二聚体可有效的评估APE患者病情严重程度及预后，可为临床APE患者个体化治疗，降低其死亡率提供客观依据。

ObjectiveTo evaluate the clinical value of heart-type fatty acid-binding protein （H-FABP） and D-dimer in assessing the prognosis of acute pulmonary embolism （APE）. MethodsTotaly 120 APE patients were hospitalized from January 2011 to December 2014 and enroled in this study. The plasma H-FABP and D-dimer level were measured by enzyme-linked immunosorbent assay. The APE patients were divided three groups including low-risk, middle-risk and high-risk group by European heart association new guidelines. According to the clinical prognosis, the APE patients were divided into survival and death group. The H-FABP and D-dimer level in different groups and the relationship with the prognosis were assessed.ResultsWith the increased severity in patients, the H-FABP and D-dimer level were significantly elevated （P〈0.05）; the H-FABP and D-dimer level were significantly higher in death group as compared with survival group （P〈0.05）. The H-FABP and D-dimer level were positively correlated （r=0.693,P=0.000）. ROC curves analysis results showed that the area under curve of H-FABP was 0.845 （95%CI： 0.752-0.918）, and optimal operating point （OOP） was 8.65 μg/L, which had 81.24% sensitivity and 84.14% specificity; ACU of D-dimer was 0.832 （95%CI： 0.728-0.899）, and OOP was 1.25 mg/L, which had 83.72% sensitivity and 82.65% specificity.Conclusion The H-FABP and D-dimer can effectively assess severity and prognosis of APE patients, meanwhile, it provide an objective basis for the clinical individual treatment and reducing the mortality rate of APE patients.